Day/Night Cycle in Delirious Adults: Effective in Reducing Delirium?

This presentation discusses the effectiveness of day/night cycle in reducing delirium in delirious adults. It includes a PICO question, discussion, recommendations, and references.

In delirious adults, is day/night cycle effective in
reducing delirium ?
Presented by:
Introduction:
According to the guidelines of DSM IV delirium is defined as the
abrupt change in brain that leads to the consequence of
emotional disruption and mental confusion (Bubalo 2018). The
illness can cause difficulties in thinking, communication,
concentrating, sleep, memory and cognitive impairment as well.
In severe cases, patient can experience thought disorder,
disorientation and hallucination (Luther & McLeod 2017).
Patients have also been found to suffer from delirium due to
alcohol withdrawal and after surgery in hospitals because of
different medications (Martinez et al. 2017). It has been found
that approximately 14% to 56% elderly patients experience
delirium during hospitalization and most of them aged 65 years
or above () Teegarden & Prough 2016). Study has informed that
57% patients with bypass surgery suffer from delirium (Martinez
et al. 2017). According to Luther and McLeod (2017), the
symptoms of delirium remain under diagnosed in most cases.
Thus, it has now become one of the major concern of health
system. Hence, it is important to introduce adequate researches
to identify the risk factors of delirium and implement effective
strategies to achieve positive health outcomes.
PICO question:
Population: Delirious adults
Intervention: Day/night cycles
Comparison: No intervention.
Outcomes: Effective in reducing delirium.
Question: In delirious adults, is day/night cycle
effective in reducing delirium?
Methods:
Effective data bases such as Medline, PubMed and
CINAHL have been used via UTS online between
01/10/2018 and 05/10/2018 to find out relevant
articles. In order to address the PICO question,
literatures was selected with full-text, which have
mentioned the use or effectiveness of using day/night
cycle to reduce or manage delirium.
Relevant keywords:
• Delirium
• Day/night cycle
• Managing delirium
• Reducing delirium
• Assessing delirium
Inclusion Criteria: Articles within 10 years, written in
English and 4 best articles were selected for this poster.
The result and findings of the articles are listed below.
Discussion:
Sleep disturbance has been found to affect the circadian rhythm which could lead to the
development of delirium. Sleeping disorder has been identified as one of the symptoms
of delirium as well. Thus, it is essential to introduce adequate interventions to improve
the sleeping pattern of the delirious adults to improve their health condition (Teegarden
& Prough 2016). In this regards, maintaining day/night or sleep-wake cycle has been
found to be effective in reducing delirium. Study has informed that using day/night
cycle to improve sleep pattern could reduce the risk of delirium by 10% (Luther &
McLeod 2017). Thus, it can be said that day/night cycle is effective in reducing delirium
in delirious adults.
Recommendations:
As a result of reviewing the studies, if day/night cycle was effective in
reducing delirium, the best recommendations are given below:
•Keep the room of the patient with delirium dark at night to reduce
interruptions during sleep (Bubalo 2018).
•Maintain proper routine for the patient to go to bed at night and
wake up at morning (Martinez et al. 2017).
•Dexmedetomidine could be used to produce non-rapid-eye-
movement that induce sleep and maintain day/night cycle (Teegarden
& Prough 2016).
Conclusion:
From the above discussion it can be concluded that, delirium is an
abrupt change in brain that causes emotional distress and several
cognitive impairments. People aged 65 years or above in hospital have
been found to suffer from delirium in most of the cases. From the
researches that was conducted, delirium is the illness which can also
be caused due to alcohol withdrawal or after surgery. In addition to
that, studies have indicated that beside pharmacological
interventions, there are significant non-pharmacological interventions
as well, for example day/night cycle. Using day/night cycle to improve
sleep pattern could help to reduce delirium effectively. Medication like
Dexmedetomidine could be used to improve day/night cycle. It is
found that with the effective strategies to improve day/night cycle,
delirium could be managed.
References:
• Bubalo, J. 2018, ‘Managing the Mental Distress of the Hematopoietic Stem
Cell Transplant (HSCT) Patient: a Focus on Delirium’, Current hematologic
malignancy reports, vol. 13, no. 2, pp. 109-113.
• Luther, R. & McLeod, A. 2017, ‘The effect of chronotherapy on delirium in
critical care–a systematic review’, Nursing in critical care, vol. 261, no. 21.
• Martinez, F.E., Anstey, M., Ford, A., Roberts, B., Hardie, M., Palmer, R., Choo,
L., Hillman, D., Hensley, M., Kelty, E. & Murray, K. 2017, ‘Prophylactic
Melatonin for Delirium in Intensive Care (Pro-MEDIC): study protocol for a
randomised controlled trial’, Trials, vol. 18, no. 1, pp. 4.
• Teegarden, B. M. & Prough, D. S. 2016, ‘Delirium prevention: another piece
of the puzzle’, Journal of thoracic disease, vol. 8, no. 12, E1614.
Result
(….)
CASP tool Martinez et al., 2017 Bubalo, 2018 Luther & McLeod, 2017 Teegarden & Prough, 2016
Was there a clear statement of the aims of
the research?
Clear aim provided such as to determine
whether prophylactic melatonin administered
to critically ill adults, when compared with
placebo, decreases the rate of delirium.
The aim of the study was To highlight the
breadth and types of mental distress
experienced by hematopoietic stem cell
transplant (HSCT) patients and highlight
the need for better prevention and
management of delirium.
The study aimed to identify whether
chronotherapy reduce the prevalence of
delirium in adult patients in critical care or
not.
The study aimed to determine the
effectiveness of dexmedetomidine in delirium
in elderly patients admitted to the intensive
care unit.
Is the methodology appropriate? Randomized placebo control study is
appropriate.
Recent publications to identify the risk factors
of delirium and effective non-
pharmacological treatment was done.
Review of the previous quantitative studies is
effective for the study.
Randomized, double-blind, placebo-
controlled trial is appropriate for the study.
Was the research design appropriate to
address the aims of the research?
Delirium measured within 850 patient and
polysomnographic test has been done to
measure quality of sleep.
20 papers have been used to identify the risk
factors of delirium and effective non-
pharmacological treatment and interventions
to manage the patient with delirium.
Six effective electronic data bases were used
for the research.
700 patients were examined and treatment
plan was documented for the research.
Was the recruitment strategy appropriate to
the aims of the research?
Yes, the trial has been performed in the ICU in
Australia. 850 patients from ICU have been
recruited.
Yes, morbidity associated with delirium
during HSCT has been identified.
Six primary research articles have been
identified that are associated with the impact
of chronotherapy.
Yes, elder patient with delirium from ICU have
been recruited.
Was the data collected in a way that
addressed the research issue?
Data has been collected based on the
prevalence, severity and duration of the
delirium and sleep quality, mortality
morbidity and patient’s participation as well.
Data collected after 6 to 12 months of HSCT
process and its impact on quality of life and
sleeping pattern.
Yes, the researchers have identified four
effective themes to collect the data.
Data regarding the effectiveness of
dexmedetomidine on improving sleep-wake
cycle has been collected.
Have ethical issues been taken into
consideration?
Yes, ethical consideration has been taken
from the Sir Charles Gairdner Hospital Human
Research Ethics Committee and the Hunter
New England Human Research Ethics
Committee.
Ethical consideration has not been considered
as the study sis not contain animal or human
subject.
Ethical approval has been provided by
Department of Anesthesia, Zhongshan
Hospital, Fudan University, Shanghai, China.
Was the data analysis sufficiently rigorous? Yes, independent intensivist, an
epidemiologist and a statistician have been
recruited to analyze the data. Haybittle-Peto
stopping rule has been used for analysis.
Data analysis is not mentioned in details. The papers were critically appraised by using
critical appraisal tool and four themes were
identified to and evaluated critically to
answer the research questions.
The study did not explain the data analysis in
details.
Is there a clear statement of findings? Yes, sleep disturbance play a significant role in
the deteriorating condition of the delirium
patients and day-night cycle play an
important role to improve the sleep pattern
of the patient.
Yes, maintaining normal day-light cycle has
been found to be effective to manage
delirium. Keeping the room dark to reduce
interruption during sleep and maximize the
exposure to sunlight during day has been
recommended.
Yes, Sleep disturbance is one of the symptoms
of delirium and sleep disturbance is
associated with circadian disruption which
may lead to the development of delirium. It
has been found that effective day-night or
sleep-wake cycle could help to reduce the
sleep disturbance by improving the
Circadian rhythm.
Yes, improving sleep pattern have been found
to be effective process of reducing delirium.
Dexmedetomidine helps to produces non-
rapid-eye-movement that induce sleep-like
state during night-time infusions that helps to
preserve day-night sleep cycle and improve
the sleep pattern of the patient.
How valuable is the research? The research informed about the importance
of maintaining day-night cycle in order to
improve sleep pattern of the patients which is
valuable in nursing practice.
The study has informed about effectiveness of
day-night cycle to reduce the interruption in
sleep and benefits of exposure to sunlight.
The study has informed that nursing practice
about the importance of sleep-wake cycle in
improving Circadian rhythm which could help
to improve clinical practice for delirium.
The research has informed about the
effectiveness of Dexmedetomidine in
improving sleep pattern of the delirium
patients, thus it is useful for the nursing
practice to facilitate the delirium patient to
manage their illness.